Fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Fiberoptic bronchoscopy was performed in 30 cases of suspected pulmonary tuberculosis. Sputum was negative for tubercle bacilli in all the patients, but in specimens obtained at bronchoscopy tubercle bacilli were found in 86.6%. By postbronchoscopy sputum smear examination tubercle bacilli were detected in 73.3% of the cases.     

The role of fiberoptic bronchoscopy in evaluating the causes of pleural effusions

To evaluate the diagnostic merit of fiberoptic bronchoscopy in pleural effusions, we performed fiberoptic bronchoscopy in addition to thoracocentesis and closed pleural biopsy in 140 patients who were admitted for diagnostic investigation of the causes of pleural effusions. The patients were divided into subgroups based on clinical features and roentgenographic findings of chest x-ray films. In 39 patients, the pleural effusions were due to various nonneoplastic disorders and in 95 patients it was caused by malignancy. In six patients, the causes of the pleural effusions remained undetermined. A final diagnosis was made by pleural examination in 68 patients, by fiberoptic bronchoscopy in 58 patients, and by either one or both in 100 patients. In 82 patients who had no hemoptysis, a final diagnosis was made by pleural examination in 57 cases and by fiberoptic bronchoscopy in 11 cases only. The diagnostic yield of fiberoptic bronchoscopy (47/58) was superior to that of pleural examination (11/58) in 58 patients presenting with hemoptysis. In 74 patients who had pleural effusions as the sole roentgenographic abnormality, the final entity was established by pleural examination in 45 and by fiberoptic bronchoscopy in 12. The diagnostic merit of fiberoptic bronchoscopy was significantly higher in 59 patients who had concurrent pulmonary abnormalities on their chest roentgenograms. A final diagnosis was made in 43 cases by fiberoptic bronchoscopy in comparison with 21 cases by pleural examination. For patients with unknown pleural effusions, fiberoptic bronchoscopy was more likely to yield a diagnosis than thoracocentesis with closed pleural biopsy in those who had hemoptysis or pulmonary abnormality on chest x-ray films, whereas the reverse applied when these features were absent.     

Diagnostic usefulness of transbronchial aspiration and bronchial lavage for pulmonary tuberculosis

Fiberoptic bronchoscopy is a well established methods as a useful tool in the diagnosis of pulmonary tuberculosis with smear negative cases. In order to get the early and definite diagnosis of pulmonary tuberculosis, we performed transbronchial aspiration and bronchial lavage by a fiberoptic bronchoscope in 97 patients. All patients (1) were clinically suspected of having active tuberculosis; (2) showed abnormal chest roentgenogram suggesting tuberculosis; (3) showed negative sputum smears of acid-fast bacilli, or had no sputum. The results of the study were summarized as follows: 1) Final diagnosis of study subjects were 90 patients of active pulmonary tuberculosis, and 7 patients of pulmonary atypical mycobacteriosis. 2) Sputum culture of acid-fast bacilli was positive in 22 out of 90 patients with active pulmonary tuberculosis. 3) Smear and culture examination of acid-fast bacilli of transbronchial aspirates were positive in 9 and 28, respectively out of 90 patients. 4) Smear and culture examination of acid-fast bacilli of bronchial lavage were positive in 12 and 39, respectively out of 90 patients. 5) A rapid and definite diagnosis was made in 16 out of 90 patients by transbronchial aspirates or bronchial lavage. 6) Atypical mycobacteria were detected in 7 out of 97 patients by transbronchial aspirates or bronchial lavage. 7) There were no serious complications such as pneumonia and exacerbation of pulmonary tuberculosis. These results suggested that transbronchial aspiration and bronchial lavage were useful procedures for rapid and definite diagnosis of pulmonary tuberculosis.     

Role of fiberoptic bronchoscopy in patients with hemoptysis and a normal chest roentgenogram

We reviewed the charts of 48 consecutive patients who had fiberoptic bronchoscopy performed in the evaluation of hemoptysis with a normal chest roentgenogram. Fiberoptic bronchoscopy provided a diagnosis other than endobronchial inflammation in only four patients--benign fibromuscular polyp in one patient, Mycobacterium tuberculosis in 1 patient, and carcinoma in two others. A literature review revealed an overall 3 percent incidence of bronchogenic carcinoma in patients with hemoptysis and normal findings on chest roentgenogram. Other than abnormal findings on chest roentgenogram, risk factors for carcinoma in patients with hemoptysis include: (1) age greater than 40; (2) significant smoking history; and (3) duration of hemoptysis for longer than one week. We concluded that in patients with hemoptysis and normal chest x-ray film findings, routine fiberoptic bronchoscopy may not always be indicated to rule out malignancy.     

A rare form of urinary bladder cancer metastasis to lung

Sixty-seven year old male patient has attended with cough and sputum complaint. He had been operated because of transitional cell urinary bladder carcinoma four years ago. He had previous medical history of pulmonary tuberculosis 27 years ago. In chest X-ray, multiple cavitary appearances were present. In computerized tomography (CT) of the thorax, bilateral multiple cavities were seen. Sputum smear examinations for acido resistant bacilli (ARB) were negative for nine times. CT guided fine needle aspiration biopsy was performed and he was diagnosed as "pulmonary metastasis of transitional cell urinary bladder cancer". This patient is presented because of the interesting radiological appearance and rare presentation of the case.     

Cryptogenic hemoptysis. Clinical features, bronchoscopic findings, and natural history in 67 patients

We reviewed the clinical outcome of 67 patients with hemoptysis and a normal or nonlocalizing chest roentgenogram and nondiagnostic fiberoptic bronchoscopic examination. During a 38 +/- 22 (SD) month period after bronchoscopy, 57 (85%) patients remained well without evidence of active tuberculosis or overlooked bronchogenic carcinoma, and 9 patients died of nonpulmonary conditions. One patient developed bronchogenic carcinoma 20 months after bronchoscopy and resolution of symptoms. Hemoptysis had resolved completely before hospital discharge in 38 (57%) patients, within 6 months in 60 (90%), and recurred in only 3. Five patients (7.5%) had intermittent episodes of bleeding for more than 1 year. Fiberoptic bronchoscopy effectively excludes specific underlying causes of hemoptysis in the setting of a normal chest roentgenogram. The prognosis for patients with cryptogenic hemoptysis is generally good, usually with resolution of bleeding within 6 months of evaluation.     

Diagnostic role of fiberoptic bronchoscopy for mycobacterial diseases]

From 1981 to 1991, 5,572 patients underwent bronchoscopic examination, in this series 3,754 patient's samples were sent for determination of mycobacterial isolation. In the 506 samples, mycobacterial bacilli were detected with smear or culture. In the low tuberculous incidence area like northern part of America, many reporters supported the opinion that routine bronchial aspirate detection for tuberculosis was not cost-effective. Inversely, in the high tuberculous incidence area like Hong Kong, M. lp et al. claimed the usefulness of routine bronchial aspirate examination for mycobacterial bacilli. Japan was regarded as moderate tuberculous incidence area. We review a ten-year experience with fiberoptic bronchoscopy for mycobacterial isolation. Our results suggest that in an area with a moderate prevalence of tuberculosis, bronchoscopic examination for mycobacterial disease is useful in the selected hospitals for the selected cases. In Japan, the smear positive prevalence has been on the increase from 1982. We estimate that the Japanese popularization of fiberoptic bronchoscopy may influence a part of the Japanese epidemic statistical analysis of mycobacteriosis.     

Bronchoscopy to evaluate hemoptysis in older men with nonsuspicious chest roentgenograms

Six of 106 older men with hemoptysis and a nonsuspicious chest roentgenogram who underwent fiberoptic bronchoscopy were found to have cancer. Four of the five bronchogenic carcinomas appeared to be surgically resectable. Cancer patients were significantly older, had smoked within the last five years, and had a significantly higher frequency of central abnormalities on chest roentgenogram. Six additional bronchogenic carcinomas were diagnosed at follow-up. Two of these were probably present but not detected at the time of bronchoscopy. We conclude that (1) hemoptysis with a nonsuspicious chest roentgenogram carries an appreciable risk of cancer in older men with substantial smoking histories, (2) these cancers are often resectable, (3) a chest roentgenogram in which the central lung fields are obscured in any way should not be considered negative in patients with hemoptysis, and (4) a negative bronchoscopic examination does not exclude the possibility of cancer in these patients.     

Endobronchial tuberculosis revisited

Analysis was made of 20 patients with endobronchial tuberculosis proven by fiberoptic bronchoscopy and bronchial biopsy. Unlike prechemotherapy reports, the disease affects the older age group and more men. Only one half of the patients had fever, and the characteristic localized wheeze was found in 15 percent of cases. Chest roentgenogram showed typical collapse-consolidation in most cases; however, it was clear in 20 percent of patients. Sputum/smear was negative for AFB in 85 percent of patients. When the gelatinous granulation tissue was not found during bronchoscopy, a diagnosis of bronchogenic carcinoma was made incorrectly in 30 percent of patients. At a mean period of 27 months postchemotherapy, all 12 patients recalled for study developed bronchostenosis proven by bronchoscopy/bronchography except one. Noninvasive methods such as chest roentgenogram and flow-volume loops were insensitive for detection of stenosis. Steroid therapy probably did not influence outcome of tuberculous endobronchitis.     

Sputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome

The diagnostic utility of sputum examination in patients with Pneumocystis carinii pneumonia secondary to the acquired immunodeficiency syndrome (AIDS) has so far not been determined. Sputum was induced in 43 patients with AIDS or suspected AIDS just prior to fiberoptic bronchoscopy, scheduled because of an unexplained pulmonary infiltrate on a chest radiograph. Pneumocystis carinii pneumonia was diagnosed by sputum examination and/or by a bronchoscopic procedure in 20 patients. Of these, sputum samples were positive for Pneumocystis organisms in 11 (55%) of 20 patients tested, bronchial washings were positive in 11 (79%) of 14 patients tested, brush biopsies were positive in 9 (53%) of 17 patients tested, and transbronchial lung biopsies were positive in 18 (90%) of 20 patients tested. The presence of P. carinii cysts in sputum did not correlate with the presence of alveolar macrophages in sputum nor with the volume of sputum. Sputum examination for P. carinii organisms, employed as a first diagnostic step in patients with AIDS with pulmonary infiltrates, may frequently obviate the need for bronchoscopy.     

Correlation between bronchoscopically visible aspects and histopathologic results in patients with suspected lung cancer

The aim of our study was to determine correlation between bronchoscopically visible lesions and histopathologic classification and whether cytology and histopathology can complement each other in diagnosis of pulmonary neoplasm. Fibroptic flexible bronchoscopy was performed in 208 patients who where suspected of having lung cancer--abnormal chest x-ray or hemoptysis. Material for histopathologic examination was obtained from bronchial brushings, bronchial forceps biopsy and bronchial washings. Positive results were classified as non--small cell or small cell carcinomas. All patients were questioned about smoking history. In 165 patients there were visible signs of neoplasm in bronchoscopic examination: tumor, necrosis, infiltration, compression. Histopathology was positive in 90 cases:small cell carcinoma 32%, non-small cell carcinoma 68%. In 23 cases material for histopathologic examination was obtained from both bronchial brushings and foceps biopsies: results were compatible in 78%. Bronchial brushings identified neoplasm in three additional cases. In analysed group of 208 patients cancer cells were found in 43%. Examination of bronchial brushings coplements forceps biopsy in diagnosing and typing lung neoplasms and could be performed more frequently in patients undergoing fiberoptic bronchoscopy.     

Extension of pulmonary tuberculosis after fibreoptic bronchoscopy

Two cases are described in which the diagnosis of pulmonary tuberculosis was suspected on both clinical and radiological grounds. Sputum smear and culture were negative for acid fast bacilli. Consequently a bronchoscopy and bronchial washings from the affected lobe were undertaken. While this procedure achieved a positive diagnosis of pulmonary tuberculosis, it also resulted in a significant extension of the disease.     

Bronchial adenoma--an eleven-year experience.

Thirteen patients with bronchial adenoma were investigated. Most of these were young males and had recurrent hemoptysis and chest infection. Radiographs of the chest were abnormal in 11 patients. The tumor was visualized by fiberoptic bronchoscopy in all but one patient. The procedure was safe and none of the patients had massive hemoptysis following bronchoscopic biopsy. Limited follow-up revealed good results following surgery.     

纤支镜检查并发症的回顾性分析及其处理

目的探讨纤支镜检查的并发症及其处理方法。方法回顾性分析2003年1月-2008年1月1658例纤支镜检查并发症的发生情况。结果1658例接受纤支镜检查患者中,鼻出血占首位,喉、支气管痉挛居第二位,其他并发症有咯血、心血管并发症等。结论良好的麻醉是纤支镜顺利进行的基本条件,操作者技术熟练,动作轻柔,严格无菌操作,严格掌握适应症,才能减少并发症。     

成人血行播散性肺结核202例临床及影像分析

目的通过对血行播散性肺结核临床资料的分析,提高对该病的认识。方法回顾性分析1998—2008年收治的成人血行播散性肺结核202例的临床资料、影像学特点、误诊情况及治疗反应。结果（1）中青年患者占80.2%, 老年患者占19.8%。（2）痰涂片查抗酸杆菌（AFB)阳性率为20.7%;31例AFB阴性患者中35.5%纤维支气管镜检抗酸杆菌阳性。（3）12.9%X线胸片早期表现为肺间质磨玻璃样改变,51.5%表现为大小、密度、分布均匀的粟粒结节。（4）胸部高分辨CT显示55.0%急性血行播散型表现双肺弥漫分布的大小、密度均匀的粟粒结节;另48例亚急性和慢性血行播散性肺结核表现以上中肺野为主的3～7mm大小、密度及分布不均匀的结节。46.8%的肺野内可见斑片、结节、纤维条索状影;43.1%伴纵隔和/或肺门淋巴结肿大。（5）20例活组织检查60%病理阳性。 （6）44.6%合并肺外结核,常见于脑膜、浆膜腔、淋巴结、脑、肝、脾、骨等。（7）42.1%入院前被误诊为其他疾病。（8）除8例外其余患者抗结核治疗后体温在3d到12周内降至正常。（9）79.7%在抗结核治疗2个月后胸片显示病灶不同程度吸收。结论痰涂片、HRCT、纤维支气管镜及器官组织活检是早期诊断的关键。     

支气管镜在气管支气管结核诊断中的临床价值

目的探讨支气管镜检查在气管支气管结核诊断中的临床应用价值,以用于气管支气管结核早期诊治。方法收集唐都医院呼吸内科2013年11月1日至2015年10月31日诊断的气管支气管结核212例住院患者临床资料,分析支气管镜检查结果及临床特点。结果 212例患者中,经电子支气管镜检查确诊为气管、支气管结核患者,其中痰菌阳性患者151例(71.2%),合并肺结核者195例,合并其他肺外结核者17例,具有结核中毒症状者182例,支气管镜下溃疡坏死型最多(29.7%)。由于气管支气管结核临床表现不特异,临床误诊率高,本组212例患者中,误诊率高达25.9%,误诊时间最长为8个月,临床危害大。结论支气管镜检查在气管支气管结核诊断中具有重要的临床价值。     

A case of endobronchial inflammatory pseudotumor invading the mediastinum

A 50-year-old-male was admitted to our hospital in March 2007, complaining of cough and hemoptysis for 3 months. Postero-anterior chest X-ray showed an opacity on right upper zone. Computed tomography of the thorax showed a mass lesion occupying the right upper lobe and superior segment of the lower lobe and invading the mediastinum. Fiberoptic bronchoscopy showed total occlusion of the right upper lobe bronchus by the mass and infiltration of the bronchus intermedius. Bronchoscopic biopsies were nondiagnostic. PET-CT revealed SUVmax of 18.8. Right thoracotomy was performed. Vena cava superior and right pulmonary artery was invaded by the mass. Biopsies were performed. Histopathologic examination demonstrated an inflammatory pseudotumor. Corticosteroid treatment was started. The tumor was clinically and radiologically unresponsive to corticosteroids. He was referred to oncology department for radiotherapy. The patient died on November 2007.     

经纤维支气管镜微导管治疗肺大咯血几种不同置人方法安全性的评价

目的探讨经纤维支气管镜微导管治疗肺大咯血几种不同置入方法的安全性。方法总结我科2010年10月至2011年12月大咯血患者10例,均为男性,通过对比观察手术过程难易程度、耗费时间、并发症等指标及治疗效果判定,对导丝引导法（方法A）、并行法（方法B）、体外留置支气管镜法（方法C）三种经纤支镜置入微导管治疗肺大咯血的安全性进行评价。结果在10例患者中,方法A完成3例,方法B完成2例,方法C完成5例,三种不同方法经纤维支气管镜下置入微导管操作均顺利,操作时间3—30min不等。方法A、B中均有病例出现鼻腔出血、声音嘶哑,方法C则无。三种方法中均无明显胸痛、肺不张、阻塞性肺炎、导管滑脱及局部支气管黏膜坏死的发生。结论对于微导管置人方法的选择,应选择术者较熟练、简便、费时短的方法,以充分保证患者的安全。体外留置纤支镜法置入微导管值得在肺大咯血中进一步推广应用。     

支气管黏膜角化症并发支气管结核一例并文献复习

分析陕西省结核病防治院收治的1例支气管黏膜角化症患者的临床资料及诊治经过,并搜集相关文献进行复习。患者为1例27岁男性农民,收治于2014年1月26日,临床表现主要为咳嗽、咳痰、胸痛、呼吸困难,胸部CT检查未见活动性病灶,行纤维支气管镜检查显示大量黄色胎膜样物质附着,痰结核分枝杆菌培养阳性。纤维支气管镜下病理检查显示,支气管黏膜表面覆盖鳞状上皮伴角化过度,符合支气管黏膜角化症并发支气管结核的诊断。给予异烟肼、利福平、吡嗪酰胺、乙胺丁醇进行抗结核药物治疗,同时给予碳酸氢钠、地塞米松及重组人表皮生长因子反复在支气管镜下灌洗并进行冷冻治疗,6个月后镜下附着物完全吸收。随访4年,患者工作、生活正常。作者综合文献分析,认为支气管黏膜角化症并发支气管结核临床症状和特征缺乏特异性,确诊主要依靠病史及病理诊断;可根据患者的具体情况,实施抗结核药物治疗,以及联合纤维支气管镜冷冻、镜下给药治疗等,患者可以得到治愈。     

Fiberoptic bronchoscopy in patients with haemoptysis and normal chest roentgenograms.

Over the last 10 years, 53 patients with hemoptysis, but with a normal chest radiograph underwent diagnostic fiberoptic bronchoscopy. Forty-three patients did not show any abnormal findings, the site of bleeding could be localised in five and non-specific mucosal changes were seen in the remaining five patients. Thirty-two patients were followed up clinically for a 3-18 months period. One patient on follow-up developed tubercular pleural effusion. Bronchogenic carcinoma was not detected in any of these patients during the procedure or at follow up. A review of literature revealed a 3 per cent incidence of bronchogenic carcinoma and the risk factors associated with higher incidence were age above 40 years, cigarette smoking and a longer duration of hemoptysis. We conclude that fiberoptic bronchoscopy has little role in this relatively benign condition (hemoptysis) especially when the risk factors are absent.